Vaccine distribution plan detailed in meeting with Montana community leaders

Officials said Tuesday that Montana has plans for distributing COVID-19 vaccines once they are available, but they are taking it day-by-day as new information comes up.

Montana’s plans for distributing the vaccines were presented to the state’s recently formed Vaccination Plan Coordination Team Tuesday by Department of Public Health and Human Services officials.

DPHHS Deputy Director Laura Smith, who coordinates the team, described it as a power-house group of local leaders and she’s hoping to keep everyone in the loop as the situation changes day-to-day.

Lt. Gov. Mike Cooney, who delivered opening remarks, said the purpose of the team is to provide broad representation to the people of Montana and the organizations affected by the vaccine plan and to provide ideas, ask questions and raise concerns when necessary.

He said recent news of vaccines for COVID-19 have provided a glimpse of light at the end of the tunnel, but said that shouldn’t be taken as a sign to relax.

“COVID-19 had impacted us all, from our stressed health care system to our tribal reservations, K-12 schools, universities, long-term-care facilities, businesses, churches, child-care facilities, the list just goes on and on,” he said. “It’s been a trying nine months and it will continue to be but we cannot let our guards down.”

The plan itself was presented by Communicable Disease Control and Emergency Preparedness Bureau Chief Bekki Wehner, formerly the department’s immunization program manager, who described it as a living document that is sure to change as more information about the vaccines come in.

She said the document is based on a playbook published by the CDC in October of this year, and the department is already working on a new version which may be done within a week.

Wehner said the department has experience in vaccine distribution, particularly during the days of H1N1, and they’ve been working on emergency planning for many years, but they weren’t anticipating anything quite like COVID-19.

The plan lays out the department’s current priorities for who the vaccine will be going to, she said, as the state will likely have a relatively small amount of the vaccine at first.

Top priority vaccinations

The first phase of this plan, she said, will prioritize front-line health care workers both for the high risk they’re at of contracting the virus and the importance of their work amid the pandemic.

However, Wehner said, the fact that it’s still unknown how much of the vaccine Montana will get at first complicates matters, along with actually defining what is considered front line in the health care world.

She said ambulance workers and firefighters will be considered part of that group.

Wehner said, based on estimates, the state has 45,000 to 65,000 health care workers, meaning 90,000-100,000 doses of the vaccine would be necessary to get all of them vaccinized, as both Pfizer and Moderna’s vaccines require two doses.

She said the CDC is taking steps to make sure that a second dose will always be available to people who got the first dose.

Wehner said providers administering the vaccine will be sent supply kits along with the vaccine that will include a card that will allow people to get the second dose, even at another clinic.

She said when enough becomes available, the state will move to vaccinate non-front-line health care workers as well as people living in long-term care facilities and others at high risk for poor outcomes should they contract the disease.

As the state receives more of the vaccine, but before they have enough for the general public, they will prioritize those with underlying health conditions, and tribal communities.

The final phase would see the general public have access to the vaccine which, Wehner said, she suspects will be some time in Spring 2021.

Wehner stressed that the tiers of priority may well change as recommendations regarding the vaccines come in from the Food and Drug Administration or the Advisory Committee on Immunization Practice.

She also said, as with front line health care workers, these groups still have yet to be technically defined in many cases, which the department will be looking at going forward.

Storing and administering the vaccine

Wehner said the state has a lot of partners already who can provide the vaccine, but they’re trying to get more and make sure that they are prepared not just for administration, but storage as well.

She said this is particularly important when it comes to the Pfizer vaccine, which requires ultra-cold storage and comes in a minimum order size of 975 doses.

“Not only does a facility need to be able to store this vaccine appropriately, they also need to be able to vaccinate a large number of people in a small amount of time,” Wehner said.

She said the Pfizer vaccine comes in containers that can hold them at sufficiently cold temperatures for 10 days, but there are sites in Montana that can store the vaccine as well.

She said the state has six or seven known sites spread around Montana and the CDC has told DPHHS that Montana is actually in a relatively good position compared to many other states.

Wehner said the plan is to try have vaccine shipped directly to areas rather than using these facilities as staging areas.

She said most facilities will not be able to order the vaccine directly at first due to its limited supply.

A member of the team suggested putting together a system for transit that would prioritize people traveling to get their vaccine.

Smith said that was an excellent idea and they would try to work that into the plan.

Moderna’s vaccine, which is set to become available a few weeks after Pfizer’s, is far easier to store, requiring only a normal freezer, and has a minimum order of 100, which Wehner said makes it far more practical for rural areas in the state.

She said, despite the challenges involved in vaccine distribution, Montana has no major gaps so far.

“At this point, we’re pretty confident that we have the systems in place to make sure that, even in rural communities, we have vaccinators,” she said.

When it comes to long-term-care facilities, she said, the vast majority of them are provided for by CVS or Walgreens, with only a handful in the state that cannot be provided for through the state’s existing partnership with the two companies.

Wehner said she’s coordinating with potential providers and the CDC to make sure that people know how to store and administer these vaccines properly.

She said providers need to fill out a form with information on their prescribers, their normal client base for vaccination and their capacity for data reporting, which she said will be crucial for these facilities.

As part of the enrollment, she said, providers will need to be prepared to send data back to her department in order for everyone to be kept track of and DPHHS is making the necessary upgrades to their own systems to make that happen.

Tracking reactions

Wehner also said the department is setting up a system to report any adverse reactions to the vaccine and data on that will need to be provided as soon as possible so it can be tracked and analyzes.

She said said most providers and people are connected to the system already through their electronic health records and ways exist to solve that problem for people and organizations that are not in the system yet.

She asked facilities to reach out to the department if they need help, and assured members of the group that targeted vaccination wouldn’t likely require any extensive retrofitting at these facilities.

Much still unknown

Wehner said it’s important to note that it’s still not set in stone when these vaccines will be available and nor is it know when/if new vaccines are coming out of trial either.

She said it’s also not yet known what the recommendation is for people who have had or currently have COVID-19 on whether they should get the vaccine.

She also said it’s been reported that the Pfizer vaccine is 90 to 95 percent effective, but there are still questions about what that means particularly whether that percentage in uniform across age groups.

Wehner said there have yet to be any vaccine trials on children so, for now, it is not being recommended that anyone younger than 18 get the vaccine.

She said the department will likely know more after the FDA finishes its evaluation of the vaccines.

Informing the public

Wehner said the plan also includes ideas for keeping the public informed, which will be the best way to make sure people know how important it is that they get this vaccine.

She said this is especially important when taking into account the misinformation that will surely spread across the internet as the vaccine becomes available.

To that end, she said, it’s important that people understand emergency use authorization.

This is what Pfizer and Moderna are applying for and allows the FDA to clear something for use in the case of an emergency situation like the COVID-19 pandemic without the need for full approval.

As a result, people getting the vaccine will be asked to sign a consent form.

Wehner said the vaccine will require no out-of-pocket expense regardless of insurance level.

She said the state is working with Medicare, Medicaid, and private insurance companies to make sure administrative fees are covered.

She said the state is also working on a mechanism to pay those fees for the uninsured and underinsured.

Smith said the next meeting of the team will likely be on a day in the week of the Dec. 14 from 10 a.m. to noon and suggested that the team consider dividing into subgroups based on their expertise and interests between now and then.

Wehner also said she’s looking for information from team members about their communities and the people who live there for specific concerns which will inform the further evolution of the plan.

She said her department has been tasked by the CDC to enroll more COVID-19 vaccination providers.

After creating mobile clinics was suggested, Wehner said that may be difficult, especially with the Pfizer vaccine’s storage requirements, a subject she went into more detail on during the meeting.

Another suggestion from a team member was to determine where workers and residents of homeless shelters fit into things and Wehner said that would be looked at as well.

During the meeting many team members provided questions and suggestions which DPHHS officials said were excellent and insightful.

State Medical Officer Greg Holzman said the questions asked during the meeting were valuable and will be used for further development of the plan or be sent back to the federal government and the CDC.